Pangasinan Province Contraceptive Self-Reliance Experience

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					             Pangasinan Province:
     Contraceptive Self-Reliance
            Experience
                        Philippines

Local Enhancement and Development (LEAD) for Health Project         Excellence
              Management Sciences for Health                               &
                                                                Innovation Influence
                                                                   PATHWAYS TO RESULTS
                October 2003 – September 2006
                      Funded by USAID                          33rd Annual International
                                                              Conference on Global Health
                                                                   May 30-June 2, 2006
                              Author                              Omni Shoreham Hotel,
                       Luzviminda N. Muego                        Washington D.C., U.S.A.
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  Population – 2.5 Million
  Land Area – 5,300 sq. km.
  Census 2000 PGR – 1.90 (2.36 Phil)
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              Family Planning Program

                                                     1991 Local
 Since the 1970’s, relied                         Government Code
 on USAID assistance                    Under Local Autonomy:
 (providing 80% of                                Re-instituted
 nation’s contraceptives)                Population and Family
                                            Planning Program


               The province’s population
               program built its capacity for a
               Management Information
               System (MIS)
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                                Census & Demographic
                          Health Surveys:1995 and 2001

                                Population Growth Rate
                         2.5
       Pop Growth Rate




                         2.0




                                                      13
                                  11




                                                   2.
                               2.




                                                                       89
                         1.5              67




                                                                    1.
                                       1.

                         1.0

                         0.5

                         0.0
                           1970        1980        1990                 2000
                                          Census Year
                                                           Source: NSO, NTSCB
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                                      Census & Demographic
                                Health Surveys:1995 and 2001
                                              Current FP Users
                         38.0
 Rate of Current Users




                         37.0


                                                         .6
                                                      37
                                                                  With
                                                                 Unmet         Current
                                   .5




                         36.0                                    Need,          Users,
                                36




                                                                 25.00%        38.00%



                         35.0                                         Non
                                1995                      2001       Users,
                                                                     37.00%
                                        DHS Survey Year
Source: Pangasinan DHS


                                                                 Source: Pangasinan DHS
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                                     The Context of CSR



 25%
     High Unmet
                                                100
       Need for                                       100% 100%
                                                90
         Family
                                                80
      Planning                                                          85%                                  Pills
                                                                                                             Injectable
                                                70
                      of Commodity Assistance
      Services                                                    70%
                          Percent Reduction



                                                60                                     65%
                                                50

                                                40

                                                30
                                                                                30%                     30%
                                                20

                                                10
                                                                                                  0                0      0
                                                 0
                                                        2004       2005            2006               2007         2008
                                                                          Commodity Assistance Year


                                                                                        Source: DOH-AO: 158, 2004
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         Contraceptive Self-Reliance

     “The ability to forecast,
 finance, procure and deliver
 good-quality and reliable
      contraceptives to
                                    CSR
    all men and women            Processes
        who need them…
   when they need them.”
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                Major Challenges to CSR:
                 Political & Socio-cultural

     National & local governments’ weak policy
      and political will to sustain population &
      family planning program.
     Local governments have limited resources
      and no policy & budget for contraceptives
      procurement.
     Political sensitivity of FP targeted service.
     Distribution system gives free access to poor
      (62%) and non-poor (38%).
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              Major Challenges to CSR:
                   Operational Barriers

                                                Highly dependent on the
                                                   public sector for
                                                   FP Services (86%)


                                  Minimal participation by
                                      private sector in
                                  FP service delivery (14%)


  As program front-liners, LGUs capacity,
  competence and preparedness for CSR
                 is low
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              Pangasinan CSR VISION

 “Sustainable
 and Quality
 Family
 Planning
 Program in
 Pangasinan”
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                                 CSR “Road Map”
 Goal: To promote LGU’s ability to sustain the provision of good quality and
                 affordable FP services and commodities

                                               Expected Outcomes
   Policies & systems for transition in-place at the LGUs
               Participation of the private sector in FP market

                           FP services operational at facility level
                                      Funding & processes
                                      institutionalized
                                                  Pangasinan: CSR
                                                  PROVINCE
      2004        2005       2006       2007                  2008
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               Initiating the CSR Strategy
     Political Will & Leadership            Achieve Commodity
      by the Governor                           Self Reliance

         Issued legal basis for CSR         Encourage Private
                                             Sector Participation
         Set policy agenda for
          reforms
                                               Reduce Unmet
         Allocated funds for CSR               Need for FP

          implementation
                                                 Strengthen
         Institutionalize all the reforms       Natural FP


                                                Segment FP
                                                  Market
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     Phases of CSR Implementation

        Organizing the         Social
             CSR           Preparation of
       Implementation     Implementers &
          Structures       Stakeholders




                             Capacity
                             Building,
       CSR Performance     formulation &
                         adoption of policy
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              CSR Performance: Results

     Policy approval and adoption by LGUs
         Commodity supply ensured during the Transition
          Period 2004 - 2008.
         Provincial Logistics Management Information
          System in place.
         29 out of 47 LGUs with contraceptives budget and
          procurement system in-place.
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                                 CSR Performance:Results
Increasing budgetary allocations for commodities by the
                  province and LGUs
                              6,000,000
       Amount Appropriatetd




                              5,000,000
                                          Province
                              4,000,000                            3,000,000
                                          LGUs
                              3,000,000              1,600,000

                              2,000,000
                                           750,000   2,405,397     2,685,500
                              1,000,000
                                           731,760
                                     0
                                            2004        2005         2006
                                                     Budget Year
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                             CSR Performance: Results
      Increasing contraceptives procurement

                              3
       Amount Appropriated




                             2.5                               Province
           (millions)




                              2                                Towns
                             1.5
                              1

                             0.5
                              0
                                   2004      2005       2006
                                          Budget Year
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                CSR Performance: Results
                                                     Injectables Sales (vials)
   Mobilizing Private               40000
                                                                                  35,556
                                     35000

    Sector Participation             30000

                                     25000


       Commercial Sector -          20000

                                      15 0 0 0

        Increasing volume of          10 0 0 0
                                                                   6,699
        contraceptive sales            5000
                                                    245
                                                0
                                                    2003             2004          2005


       Capability building for                            Pills Sales (cycles)
        private providers -        14 0 0 0 0                                        132,502
                                                                 106,874
        More midwives being        12 0 0 0 0


                                          81,806
                                   10 0 0 0 0
        trained as providers and    80000

        entrepreneurs               60000

                                    40000

                                    20000

                                           0
                                            2003                    2004                   2005
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            CSR Performance: Results
   Market Segmentation for FP targeted services

                                Groundwork for
                              Client segmentation
    Client Classification         Towards FP
       At the Public                 Market
       Sector Health             Transformation
           Facility                 • Enhanced
                               Information Generation
     Living Standard Survey     - Willingness to pay
     For ranking households      - Facility Mapping
                                   - Private Sector
                                       Mapping
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               CSR Performance: Results
   Service delivery strategies in place to reduce
    FP Unmet Need
       Tool to identify married women with unmet need
        for FP in-place and functional
       Client referral system in
        public & private facilities
        and providers
       Outreach support for client
        generation intensified
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               CSR Performance Results:
                        Moving Forward

     Replication of CSR Strategies Province-wide




2003 9 LGUs
2004 24 LGUs
2005 45 LGUs
2006 47 LGUs
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   Partnership Works for CSR Initiative

   “…we commend you in looking at
   the issue of reduced donor
   contraceptive commodity support in
   the broader perspective by working
   towards CONTRACEPTIVE SELF-
   RELIANCE.”

               From a letter to Gov. Victor E. Agbayani,
                                     USAID-Philippines
                                               Dec 2002
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           Partnership Works for CSR

     Champions for Self-Reliance in Local
      Governance for the LGUs
     Corporate Social Responsibility in Private
      Sector
     The general population, Contraceptive Social
      Responsibility
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                           THANK YOU!


      For more information…

         Provincial Population Office
         2/F Kalantiao Bldg., Capitol Complex
         Lingayen, Pangasinan
         Philippines

         Tel/Fax: (+6375) 542.6349
         Email: ppo_pang@yahoo.com